By Vibhor Krishna, MBBS
As a surgeon-scientist at The Ohio State Wexner Medical Center, Dr. Krishna has expertise in the translational applications of neuroimaging relevant to neuromodulation and functional neurosurgery. He investigates imaging-based therapies (specifically focused ultrasound and image-guided deep brain stimulation) and discovers neuroimaging correlates of efficacious neurostimulation. His imaging modalities of interest include diffusion tensor imaging (quantitative, deterministic and probabilistic tractography) and functional magnetic resonance imaging.
Recently, Dr. Krishna wrote this informational blog for patients and their families who want to know more about focused ultrasound therapy as a potential treatment option for essential tremor and tremor-dominant Parkinson’s disease.
A movement tremor can become a debilitating condition. The constant interference can also be something that you, unnecessarily, just learn to live with.
In reality, you don’t need to live with that, and a high-tech procedure at Ohio State uses ultrasound waves — instead of scalpels — to fix tremors in patients.
How is FUSA performed?
The procedure lasts about four hours. To start, the patient is placed in an MRI. While in the MRI, the patient stays awake to provide real-time feedback to the team. This helps us precisely target the brain region that controls involuntary tremors with ultrasound waves.
There is less risk for the patient because there are no incisions and no devices implanted. This reduces risk of infection and shortens the downtime for recovery.
How does FUSA work to help tremors?
Ultrasound uses sound waves that can’t be heard by humans. All sound waves create micro-movements, and the idea behind FUSA is to focus a thousand different waves of ultrasound at a single spot in the brain to burn, or ablate, specific brain tissue involved in the muscle movements associated with tremors.
I tell patients to think of a car with good horsepower, but bad brakes. The wheels still spin when you try to stop the car. Similarly, during tremors, parts of brain work harder than they should. FUSA helps calm their activity down.
How quickly does FUSA stop tremors?
Tremor reduction is practically immediate. Because the doctor and patient communicate throughout the procedure, there’s no waiting to know if tremors are eliminated. It’s permanent because the brain cells causing the tremor are ablated away. Patients recover rapidly and usually return to normal activities within the first few weeks.
What conditions can be treated with FUSA?
We believe the list of conditions that can be improved through FUSA will only grow with time. In fact, myself and other researchers at Ohio State are investigating the effects of FUSA on treating refractory epilepsy. Trials are also investigating focused ultrasound for treating Parkinson’s, Alzheimer’s disease and, in the future, neuropathic pain and certain psychiatric disorders.
Currently FUSA is approved and beneficial for patients with essential tremor and tremor-dominant Parkinson’s disease. It’s also helpful for patients who haven’t responded to medication or aren’t candidates for surgical treatments.
How do you get an appointment for FUSA?
The first step is to get a referral from your primary care doctor or specialist. Once you or a loved one notices a tremor, you should talk to your doctor. That’s especially true if tremors are interfering with day-to-day activities, such as eating, cutting your food or writing.
After evaluation, we typically start by trying some medications to improve the tremors. If those are unsuccessful, we may consider a FUSA procedure.
It’s interesting to note that essential tremor can be hereditary in families. So talking with other family members about your disease can help them. We often say our patients are ambassadors to educate others.
The important thing to know is that information empowers. Seek information. There is no harm in getting assessed and getting information to understand your disease, its severity and your treatment options.
Dr. Vibhor Krishna is a neurosurgeon and a member of the research team at Ohio State’s Center for Neuromodulation. This blog originally appeared on The Ohio State University Wexner Medical Center’s blog page on March 12, 2019.